Carcinoma of the laryngeal margin

The laryngeal margin constitutes an anatomic and clinical entity that differs from what is commonly referred to as supraglottic. The present retrospective study reviews 189 cases of carcinomas occurring in this specifically defined region. Local, nodal, and distant metastatic spread of these tumors varied depending on whether the initial tumor site was located in the anterior or lateral margin. Treatment regimens were planned according to the tumor's origin. Primary tumor site surgery associated with a modified or radical neck dissection according to N staging, followed by postoperative radiation is advocated for treatment of these tumors. Cervical nodal metastases are frequent and often bilateral (36%) in cases of anterior margin carcinoma suggesting that bilateral neck dissection sparing two jugular veins for N0 staged carcinoma and one jugular vein when there is evidence of a palpable node, be routinely used. Nodal involvement in cases of lateral margin carcinoma is also frequent but is almost exclusively confined to the ipsilateral nodes. It is suggested that homolateral neck dissection therefore be systematically associated with primary tumor site surgery for these tumors. The various anatomical aspects and pathways of extension of laryngeal margin carcinoma are discussed and a modified TNM classification is proposed.